The transactional revenue cycle no longer works: Here's what does

From left, Bob Stearnes, director of patient accounting, Covenant Health; April York, VP of patient financial Services and RCS Innovation, Novant Health; and Beau Gostomsky, VP of revenue cycle at Children’s Mercy Hospital, speak at the HFMA annual conference in Nashville. 

Photo: Susan Morse/HFN

NASHVILLE - Transactional revenue cycle no longer works with patients, especially millennials, said finance experts speaking during the HFMA conference in Nashville.

It used to be, do the service and then bill, said Bob Stearnes, director of patient accounting for Covenant Health.

Transactional was how it always was, Stearnes said. Patients got billed and if they failed to pay, they were subject to repercussions. 

"Today we're having a relationship, having conversations about your ability to pay," Stearnes told the crowd during the session, "The 'I' in Win: Win the Game with your Revenue Cycle Strategy." 

Covenant gives patients estimates and asks them how they want to pay. When they say they can't afford that amount, payment options are given.

"People are hesitant about giving information," Stearnes said. "You have to increase their comfort level to align the resources they need. We have to glean a lot of value from a little bit of information."

Patient engagement is changing, said Beau Gostomsky, vice president of Revenue Cycle at Children's Mercy Hospital. 

"Millennials operate in a different fashion than my generation did," Gostomsky said. 

Younger patients are used to digital communication beyond clinical care. But "they get the bill and it tanks," Gostomsky said.

Take credit or debit card information on the front end of the revenue cycle process, advised April York, vice president of Patient Financial Services and RCS Innovation, Novant Health. If the bill aligns with the estimate of benefits statement from their insurance company, there's no issue with patients on the back end, she said.

Patients who do have questions don't want a one-way chat, York said. This is where two-way conversations using ChatGPT can save patients from a frustrating experience.

Patient assistance applications can also be automated. "It's got to be quick, it's got to be real time," York said.

But as much as hospitals are looking at automation and AI as the future of patient connections, executives must know not only how their populations will react, but their staff.

"The challenge is knowing which way to go," Stearnes said, "making the right choices for the right returns."

If the team isn't onboard with the new technology, it's going to struggle to do well, he said.

Children's Mercy Hospital in Kansas City is in the Midwest, where there's a "Midwest nice," Gostomsky said. This also pertains to payment plans, but one family who brought their child in for an emergency will be paying $45 a month forever, he said. The hospital got a vendor partner to help with payment plans. 

"Having a good partner was essential for us," he said.

Sometimes, patients get angry about unexpected medical bills, but then they end up thanking you because you walked them through the process, Gostomsky said.

The talk is that one day, there will be no need for a back end to the revenue cycle, he said. They're not close to that yet.

"It may not be ready yet," Gostomksy said, "but it's getting better, better and better."

Twitter: @SusanJMorse
Email the writer: SMorse@himss.org